Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Dual-Anchor Cog Threads in Fat Grafting Breast Augmentation: A Novel Scarless Method for Defining Breast Footprint and Enhancing Shape

Visconti, Giuseppe, M.D., Ph.D.; Salgarello, Marzia, M.D.

Plastic and Reconstructive Surgery: April 2019 - Volume 143 - Issue 4 - p 1039-1049
doi: 10.1097/PRS.0000000000005431
Cosmetic: Original Articles

Background: Modern fat grafting breast augmentation allows successful breast enhancement. However, there is no fine control of breast footprint, shape, and inframammary fold. The purpose of this article is to report a novel scarless technique and to evaluate its beneficial effect by retrospectively reviewing case-control consecutive data from 51 patients.

Methods: Fifty-one consecutive patients undergoing cosmetic breast augmentation with fat only between September of 2012 and August of 2016 were retrospectively reviewed. In the first 29 cases (56 percent), the authors did not use threads (group A, control group), whereas in the remaining 22 cases (44 percent), the authors used dual-anchor cog threads (group B, case group). Breast shape analysis was performed separately by a blinded group of plastic surgeons and by the attending surgeon using a standardized evaluation method. The BREAST-Q was used to study patient satisfaction. The Mann-Whitney U and chi-square tests were used for categorical variables, and the independent-samples t test was used for continuous variables.

Results: No significant difference in mean graft take was found (group A, 71.2 percent; group B, 71.6 percent; p < 0.05). Group B showed a significantly higher rating than group A for lower pole profile, inframammary fold, and lateral footprint definition. No major postoperative complications were experienced in either group. In group B, no thread-related complications were experienced.

Conclusions: The dual-anchor thread suture is a novel, effective, simple, reliable, safe, and scarless method of improving breast shape in fat grafting breast augmentation. Larger series are needed to further confirm the authors’ findings.


Rome, Italy

From the Department of Plastic and Reconstructive Surgery, Catholic University of “Sacro Cuore,” Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS.

Received for publication February 19, 2018; accepted October 25, 2018.

Presented in part at the 28th Annual Meeting of the European Association of Plastic Surgeons, in Pisa, Italy, May 25 through 27, 2017; the Sixth Congress of the International Society of Plastic and Regenerative Surgeons, in Dubai, United Arab Emirates, November 17 through 19, 2017; Botti’s Best Breast, in Gardone Riviera, Italy, May 25 through 27, 2018; the 31st Meeting of the French Society of Aesthetic Plastic Surgeons, in Lyon, France, May 31 through June 2, 2018; the Rome Breast Symposium 2018, in Rome, Italy, June 13 through 15, 2018, and awarded first prize among the “under 40ies Aesthetic Challenge” oral presentations and awarded first prize among all the “under 40ies” oral presentations; and the Third Congress of the Asociacion Española de Cirugia Estetica Plastica, in Madrid, Spain, November 22 through 24, 2018.

Disclosure:Dr. Visconti is a consultant for WOW Medical, Korea and the inventor of this procedure. Dr. Salgarello has no interest in any of the products or devices mentioned in this article. No funding was received for this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (

Giuseppe Visconti, M.D., Ph.D., largo Agostino Gemelli, 8, 00169, Rome, Italy,

Copyright © 2019 by the American Society of Plastic Surgeons